Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching
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Open Access
- 30 July 2020
- Vol. 70 (1), 76-84
- https://doi.org/10.1136/gutjnl-2020-322248
Abstract
Objective The adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing. Design Data were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death). Results In the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19. Conclusion Patients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit–risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.Keywords
Funding Information
- National Research Foundation of Korea (NRF2019R1G1A109977912)
This publication has 38 references indexed in Scilit:
- Proton pump inhibitors therapy and the risk of pneumonia: a systematic review and meta‐analysis of randomized controlled trials and observational studiesExpert Opinion on Drug Safety, 2019
- Association of proton pump inhibitor use with renal outcomes in patients with coronary artery diseaseKidney Research and Clinical Practice, 2018
- Human intestinal tract serves as an alternative infection route for Middle East respiratory syndrome coronavirusScience Advances, 2017
- Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysisWorld Journal of Gastroenterology, 2017
- Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-AnalysisPLOS ONE, 2015
- Are proton pump inhibitors associated with the development of community-acquired pneumonia? A meta-analysisExpert Review of Clinical Pharmacology, 2012
- Proton-Pump Inhibitor Use and the Risk for Community-Acquired PneumoniaAnnals of Internal Medicine, 2008
- Addressing the issue of channeling bias in observational studies with propensity scores analysisResearch in Social and Administrative Pharmacy, 2006
- Risk of Community-Acquired Pneumonia and Use of Gastric Acid–Suppressive DrugsJAMA, 2004
- CYP2C19 genotype status and intragastric pH during dosing with lansoprazole or rabeprazoleAlimentary Pharmacology & Therapeutics, 2000